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PubMed2000

[Cognitive and emotional disorders in multiple sclerosis. Can a management strategy be envisioned?].

There is a lack of precise data concerning the natural history of cognitive disorders in multiple sclerosis (MS), but recent neuropsychological studies have demonstrated that the incidence of such disorders in MS appears to be frequent (40-65% of cases), and have shown in particular that recent memory, conceptual reasoning, attention, executive functions, visuospatial perception and information processing speed are negatively affected. In contrast, language functions, general intelligence and implicit memory appear to be relatively well preserved. Although the presence and the degree of cognitive disorders does not seem to be directly linked to disease duration or to the extent of physical disability, the relationship between cognitive decline and brain lesions detected by magnetic resonance imaging (MRI) is still a subject of discussion. The prevalence of emotional and affective disorders is difficult to estimate. Their frequency has only rarely been investigated, and the lack of data on the natural history of these disorders and those factors which they have in common (the psychosocial consequences of this chronic and disabling disease, cognitive impairment, and brain lesions) further complicate the determination of treatment strategy. The adoption of appropriate strategies could limit the negative impact of this disease on the social functioning of MS patients.

Cognition Disorders↗

PubMed2006

Professionalism in long-term care settings.

UNLABELLED: Speech-language pathologists who serve elders in a variety of long-term care settings have a variety of professional skills and responsibilities. Fundamental to quality service is knowledge of aging and communication changes and disorders associated with this process, institutional alternatives, and the changing nature of today's elders in long-term care. Excellence in service also involves meeting third party payers' requirements, teamwork, and advocacy. In addition, professionalism is demonstrated through maintaining privacy, ethical practice, staff and family in-service and counseling, and self-care. Innovative programming also involves developing new outcome measures and environmental engineering that enhances the communication skills and opportunities of elders in long-term care settings. LEARNING OUTCOMES: As a result of this activity, the participant will: (1) describe the changing nature of long-term care settings and residents, (2) understand the broad and complex professional skills that contribute to excellence in practice in this setting.

Aged↗

PubMed1990

The information-processing approach.

The information-processing (IP) approach to perception and cognition arose as a reaction to behaviourism. This reaction mainly concerned the nature of explanation in scientific psychology. The "standard" account of behaviour, phrased in strictly external terms, was replaced by a "realist" account, phrased in terms of internal entities and processes. An analysis of the theoretical language used in IP psychology shows an undisciplined state of affairs. A great number of languages is simultaneously in use; no level of analysis is unambiguously referred to; and basic concepts such as information and processing remain largely undefined. Nevertheless, over the past 25 years the IP approach has developed into a disciplined and sophisticated experimental science. A look at actual practice hints at the basic reason for its success. The approach is not so much concerned with absolute or intrinsic properties of the human information processor, but with what can be called its relative or differential properties. A further analysis of this feature of the IP approach in terms of the formal language of a logical system makes explicit the basis of its success. The IP approach can be regarded as developing an empirical difference calculus on an unspecified class of objects, phrased in terms of a simulated "theory-neutral" observation language, and with operators that are structurally analogous to logical operators. This reinterpretation of what the IP approach is about brings a number of advantages. It strengthens its position as an independent science, clarifies its relation with other approaches within psychology and other sciences within the cognitive science group, and makes it independent of philosophical subtleties.

Cognition↗

PubMed1975

The syndrome of Gogi (word meaning) aphasia. Selective impairment of kanji processing.

In 1943, Imura described an aphasic syndrome shown by Japanese patients and designated it as Gogi ("word-meaning") aphasia. Salient features are selective impairment of processing kanji or Chinese characters and difficulty in finding access to the lexicon in both production and reception, with preservation of processing kana or phonetic signs, and fluent oral repetition. A patient with this syndrome is presented, with emphasis on the nature of his kanji impairment. Cases of Gogi aphasia in the literature are reviewed and contrasted to cases of Broca's aphasia with selective impairment of kana processing. The implications for a neurolinguistic model of language processing in aphasia are discussed.

Adult↗

PubMed1999

Laying medicine open: understanding major turning points in the history of medical ethics.

At different times during its history medicine has been laid open to accountability for its scientific and moral quality. This phenonmenon of laying medicine open has sometimes resulted in major turning points in the history of medical ethics. In this paper, I examine two examples of when the laying open of medicine has generated such turning points: eighteenth-century British medicine and late twentieth-century American medicine. In the eighteenth century, the Scottish physician-philosopher, John Gregory (1724-1773), concerned with the unscientific, entrepreneurial, self-interested nature of then current medical practice, laid medicine open to accountability using the tools of ethics and philosophy of medicine. In the process, Gregory wrote the first professional ethics of medicine in the English-language literature, based on the physician's fiduciary responsibility to the patient. In the late twentieth century, the managed practice of medicine has laid medicine open to accountability for its scientific quality and economic cost. This current laying open of medicine creates the challenge of developing medical ethics and bioethics for population-based medical science and practice.

Bioethics↗

PubMed1995

Global logic resulting from disequilibration process.

Describing a system in which internal detection or observation proceeds at a finite velocity is always destined to end up with a form of self-contradiction. For any formal language, for such a description, we must assume that the velocity of observation propagation or VOP be infinity. In the present paper, we propose a self-referential scheme intended for formally describing a system exhibiting the process of disequilibration propagating at a finite VOP, and find that a global logic can emerge from local disequilibration. Conservative cellular automata of Margolus type, for instance, enable disequilibration to be replaced by such a process that the number of particles is not conserved globally while appearing to be conserved by local observers. One cannot determine local rules universally. Nevertheless, global logic emerges as a result of the dynamics of a one-to-many type mapping. This is a fundamental aspect of natural languages or communication relevant to natural life and intelligence.

Biological Evolution↗

PubMed2003

Modeling hospital information systems. Part 1: The revised three-layer graph-based meta model 3LGM2.

OBJECTIVES: Not only architects but also information managers need models and modeling tools for their subject of work. Especially for supporting strategic information management in hospitals, the meta model 3LGM2 is presented as an ontological basis for modeling the comprehensive information system of a hospital (HIS). METHODS: In a case study, requirements for modeling HIS have been deduced. Accordingly 3LGM2 has been designed to describe HIS by concepts on three layers. The domain layer consists of enterprise functions and entity types, the logical tool layer focuses on application components and the physical tool layer describes physical data processing components. In contrast to other approaches a lot of inter-layer-relationships exist. 3LGM2 is defined using the Unified Modeling Language (UML). RESULTS: Models of HIS can be created which comprise not only technical and semantic aspects but also computer-based and paper-based information processing. A software tool supporting the creation of 3LGM2 compliant models in a graphical way has been developed. The tool supports in detecting those shortcomings at the logical or the physical tool layers which make it impossible to satisfy the information needs at the domain layer. 3LGM2 can also be used as an ontology for describing HIS in natural language. CONCLUSIONS: Strategic information management even in large hospitals should be and can be supported by dedicated methods and tools. Although there have been good experiences with 3LGM2 concerning digital document archiving at the Leipzig University Hospital, which are presented in part 2, the benefit of the proposed method and tool has to be further evaluated.

Hospital Information Systems↗

PubMed2000

Learning about the dynamic swallowing process using an interactive multimedia program.

The management of dysphagia is the largest recognized subspecialty in the field of speech-language pathology. Practicing speech-language pathologists require a comprehensive theoretical and functional knowledge base to underpin the safe and effective management of people with dysphagia. Students need to develop an understanding of the normal integrated swallow and how it can be affected to appreciate the assessment or treatment of dysphagia. Although students are well motivated to learn this material, assimilating knowledge of the dynamic nature of the swallow has typically been problematic because of its complex character. The limitations of currently available teaching resources have been addressed by the production of an interactive multimedia program that includes integrated presentation of text, graphics, voice-overs, and video and animation sequences to highlight various aspects of the swallowing process. Students can selectively manipulate parts of this process to understand the normal swallow and to simulate different aspects of dysfunction and the consequent effects on swallow safety and efficiency. Feedback from students, faculty, and experts has demonstrated that The Dynamic Swallow would be a valued tool in the teaching of dysphagia.

CD-ROM↗

PubMed1998

Nursing terminology: a comparison of the ICNP and the nursing intervention lexicon and taxonomy.

The purpose of this paper is to provide an overview of nursing terminology work done to date and to compare the labels and subsumed terms of the recent alpha version of the International Classification of Nursing Practice (ICNP) with the verb terms (n = 147) of the interventions in a dataset of interventions (n = 7292) categorized using the Nursing Intervention Lexicon and Taxonomy (NILT). Two estimates were used to evaluate the adequacy of the ICNP terms for representing intervention terminology. Term matches were done using the NILT categories most similar to the ICNP action types. The ICNP action type 'observing' (and its subsumed terms) was best, accounting for 20% of the NILT verbs. The ICNP label 'observing' (and its subsumed terms) ranked first in accounting for 69% of the interventions in the NILT categories (CND & CV). The remaining action types had many fewer matches for the verbs and interventions in the NILT dataset. Thus it is possible to conclude that a relatively small subset of the verb terms, and interventions in a dataset of natural language interventions categorized using NILT have been captured by the INCP alpha version of Axis A.

Humans↗

PubMed2005

Evidence for a neurophysiologic auditory deficit in children with benign epilepsy with centro-temporal spikes.

Benign focal epilepsy in childhood with centro-temporal spikes (BECTS) is one of the most common forms of epilepsy. Recent studies have questioned the benign nature of BECTS, as they have revealed neuropsychological deficits in many domains including language. The aim of this study was to investigate whether the epileptic discharges during the night have long-term effects on auditory processing, as reflected on electrophysiological measures, during the day, which could underline the language deficits. In order to address these questions we recorded base line electroencephalograms (EEG), sleep EEG and auditory event related potentials in 12 children with BECTS and in age- and gender-matched controls. In the children with BECTS, 5 had unilateral and 3 had bilateral spikes. In the 5 patients with unilateral spikes present during sleep, an asymmetry of the auditory event related component (P85-120) was observed contralateral to the side of epileptiform activity compared to the normal symmetrical vertex distribution that was noted in all controls and in 3 the children with bilateral spikes. In all patients the peak to peak amplitude of this event related potential component was statistically greater compared to the controls. Analysis of subtraction waveforms (deviant - standard) revealed no evidence of a mismatch negativity component in any of the children with BECTS. We propose that the abnormality of P85-120 and the absence of mismatch negativity during wake recordings in this group may arise in response to the long-term effects of spikes occurring during sleep, resulting in disruption of the evolution and maintenance of echoic memory traces. These results may indicate that patients with BECTS have abnormal processing of auditory information at a sensory level ipsilateral to the hemisphere evoking spikes during sleep.

Acoustic Stimulation↗

PubMed2005

Effects of intralaminar thalamic stimulation on language functions.

Fifteen neurosurgical subjects, who were undergoing thalamic chronic electrode implants as a treatment for dyskinesia and chronic pain, were evaluated on a series of neurolinguistic functions to determine if the stimulation of the centromedianum nucleus of the thalamus affected language and cognitive processing. Analysis of the data revealed that the stimulation of the left centromedianum nucleus had resulted in a notable facilitatory influence on the processing of language functions; this facilitatory effect was measured in terms of the number of errors produced and the patients' response latency time. The facilitatory effect was also noted to have extended to other language functions. The nature of the facilitation from the stimulation of the left centromedianum nucleus, an extension of the brainstem reticular formation, on language functions is discussed.

Adult↗

PubMedDate not supplied

Language evolution in children with cochlear implants.

The capacity to incorporate significant words into the existing vocabulary and to use these words to form sentences with more mature syntactic structures emerges over a considerable time course in young deaf children who have undergone a cochlear implantation. The purpose of this follow-up study is to document the nature and time span of language production--in morphosyntactic and lexical skills--when a child's first experience with language sounds is provided artificially through electrical stimulation. To examine the development of these two aspects of linguistic processing, five deaf French children, all enrolled in similar postimplantation educational settings, were individually assessed at 6-month intervals over a period of 18 months. Computerized analyses were derived from their spontaneous speech in a 20-min standardized play session. Results for mean length of utterance and vocabulary revealed gradually improving performance for most children, in spite of the generally low starting point. Both measures of production nevertheless remained well below the norms established for normally hearing children. Although the achievement of higher production scores, which underlies more effective interpersonal exchanges, is evident after only 1 year of device use, it is clear that improvement does not always occur at the same pace, as shown by two of the children. This emphasizes the importance of longitudinal studies in documenting intersubject variability and intrasubject stability throughout the experience with an implant.

Child Language↗

PubMed2002

Issues contrasting adult acquired versus developmental apraxia of speech.

Acquired and developmental apraxia of speech (AOS and DAS) are defined as disorders of the transition from an abstract phonological code into motor commands. However, the natural course of these disorders differs substantially because of the fundamental difference in the developmental stage at which the apraxia expresses itself. In normal and pathological development alike, development of language and speech is an interactive process, involving speech motor control, perception, and psycholinguistic processes. Infant speech develops from random babbling and sensomotoric learning, followed by more abstract phonological acquisition. Supposing that the core deficit of DAS comprises a reduced sensomotoric learning capacity explains a large part of the symptomatology of DAS in the psycholinguistic domain because of the impact on phonological, perceptual, and higher-level processes. This contrasts with adults with AOS, who already have acquired stable top-down processes. Implications for clinical management are discussed.

Adult↗

PubMed1995

Linguistic entrapment: medico-nursing biographies as fictions.

This paper argues that in their trainings health professionals are encouraged to use language naively as if it were a transparent medium of scientific communication. We contend that language use, particularly in the field of mental health care, should be studied in terms of its social functions and attention should be paid to the inevitably constructive nature of language in patients' records, in order that a 'fictional distance' opens up between patients and their records. Recent developments in literary theory and narrative analysis can be deployed as theoretical frameworks to understand this process, and we suggest that more attention to the use of language should be included in the educational programmes for health care professionals to counteract the risk of 'linguistic entrapment' or 'incarceration'.

Linguistics↗

PubMed1981

Influence of the setting on a psychotherapeutic relationship in analytically oriented brief psychotherapy.

In this brief review, the author stresses the interest of short-term psychotherapy in the study of psychotherapeutic processes: through modifications of time and space factors of the cure (limited duration - face-to-face) one can appreciate better the influence of the setting on the nature of the process. By comparing the psychotherapeutic situation (face-to-face) to the psychoanalytic situation (back-to-face), the author highlights some specific features of psychotherapies, in particular the influence of the infraverbal language and its consequences on the cure. In a face-to-face situation for example, the subject unconsciously tries to incorporate the therapist in his ego, and this very powerful merging mechanism may hinder the evolutive process of the treatment. Some of the aspects examined apply to any doctor-patient-relationship.

Humans↗

PubMed1999

[Scientific languages and the science of complexity].

For centuries the goal of galileian and newtonian science has been the discovery of the universal laws of nature governing all natural phenomena. But, starting with the sixties of this century, advanced research has concentrated on the study of the characteristic aspects of irregular and unrepeatable evolutionary processes. Signs of this change are the rediscovery of Poincaré's results on the dynamics of non linear systems, and the extraordinary development of evolutionary thinking. Three properties characterize complex systems: the multiplicity of their levels of organization, the presence of self-referential loops of internal communication, and the irreducible nature of their past history to structural properties. The traditional cartesian gap between mind and body therefore falls down, as argued at length by the works of Gregory Bateson. His arguments are further strengthened by the neurologist Antonio Damasio in his book on reason, emotion and human brain, whose title is L'errore di Cartesio (The error of Descartes), where the negative consequences of this error on the development of science in general and on contemporary medicine in particular, are illustrated.

Biological Evolution↗

PubMed2006

[Is there a correlation between low-level auditory processing and phonological processing in preschool children?].

BACKGROUND: It appears to be widely accepted that specific language impairment (SLI) and developmental dyslexia result from some form of phonological deficit. Some theorists contend that these deficits are directly and exclusively caused by a cognitive deficit specific to representation and processing of speech sound. However, separate theories hold that phonological deficits indeed may cause SLI or dyslexia but phonological deficits arise due to sensory, mainly auditory, deficits. Here we studied if there is a correlation between two hotly debated measures of auditory low-level processing and measures of phonological processing in preschool children. METHODS DESIGN: prospective study. SAMPLE: preschool children. VARIABLES: monaural and binaural temporal order judgement (TOJ(b) and TOJ(m)), several standardized measures of broad and narrow phonological processing (Bielefelder Screening BISC). STATISTICS: correlation analysis. RESULTS: A significant correlation was found between TOJ(b)/TOJ(m )and phonological processing. However, these data show that "impaired" TOJ(b) and TOJ(m) is neither a necessary nor a sufficient prerequisite for impaired phonological processing. DISCUSSION: Although TOJ(b) and TOJ(m) as measures of auditory low-level processing show a correlation with some measures of phonological processing, the precise nature of mechanisms leading to SLI or dyslexia still remains an unsolved problem.

Articulation Disorders↗

PubMed1995

The natural history of Alzheimer's disease: a brain bank study.

OBJECTIVE: To define the natural history of Alzheimer's Disease (AD), from time of clinical (presumptive) diagnosis and/or onset of symptoms to death and to describe demographic and clinical characteristics of patients with AD. DESIGN: Retrospective medical records review. SETTING: Regional brain bank operated by a university hospital. PARTICIPANTS: One-hundred randomly selected, autopsy-confirmed Alzheimer's Disease patients. MEASUREMENTS: All information pertaining to family and clinical history (diagnoses, office visits, hospitalizations), medication use, nutritional status, and clinical testing (laboratory testing, imaging, diagnostics, and psychometric testing) was abstracted. Time of onset for behavioral symptoms (e.g., anxiety, wandering, agitation) and deficits in cognitive function (e.g., recent memory, concentration, language) and activities of daily living (ADL) were also abstracted. Data was collected on-site using a laptop computer and a series of customized data entry spreadsheets. Upon completion of the data abstraction process, data was converted to a database program for query and analysis. RESULTS: A complete natural history timeline was constructed based on the mean values observed in order to demonstrate important clinical endpoints, namely, diagnosis, institutionalization, and death. The mean time between onset of symptoms and clinical diagnosis was 32.1 months (standard deviation = 37.9 months). The interval between symptom onset and AD diagnosis was longer for patients who were less than 65 at time of diagnosis (mean = 37.6 months), female patients (mean = 34.9 months), and patients with a positive family history of dementia (mean = 37.5 months). The mean age at diagnosis was 74.7 years (standard deviation = 8.6 years), with a range of 52 to 89 years. Most patients were diagnosed between the ages of 70 and 79. Males were diagnosed at an earlier age, 72.8 years, on average, than females, 75.4 years. The mean time to institutionalization from time of clinical diagnosis was 23.9 months (standard deviation = 33.6 months). The average age at institutionalization was 77.6 years, with a minimum of 60 years and a maximum of 92.5 years. Institutionalization occurred 56.5 months after symptom onset, on average. This interval was shorter among patients with a negative family history (mean = 53.1 months) and patients diagnosed after age 65 (mean = 51.6 months). Patients diagnosed before age 65 experienced a significantly greater average time to institutionalization, 94 months (P = .01). Disease duration was measured as time from symptom onset until death. Mean disease duration was 101.3 months, or nearly 8.5 years (standard deviation = 59.2 months). Subgroup analysis showed that disease duration was prolonged in younger onset patients (mean = 129.1 months), females (mean = 107.9 months), and patients with a positive family history of dementia (mean = 106.3 months). CONCLUSIONS: These data suggest that the typical AD patient is diagnosed 32 months after symptom onset, at the age of 75 years. This patient is institutionalized 25 months after diagnosis, or approximately 57 months after symptom onset at age 78. The patient remains institutionalized for 44 months or, in actuality, until death. Total disease duration for this typical AD patient is just over 101 months, or approximately 8.5 years.

Activities of Daily Living↗